APS 2015

New research was presented at APS 2015, the American Pain Society’s annual scientific meeting, from May 13 to 16 in Palm Springs, CA. The features below highlight some of the studies that emerged from the conference.

Migraine Prevalent in Patients With Fibromyalgia

The Particulars: Fibromyalgia has been shown in several studies to be highly prevalent in patients with migraine. However, few studies have explored the prevalence of migraines in patients with fibromyalgia.

Data Breakdown: For a study, more than 1,000 patients with fibromyalgia completed a survey with questions about medical history, demographics, and migraine. More than half of respondents participating in the study met criteria for migraine headaches. Those who met the criteria were significantly more likely to report hypertension, asthma, IBS, chronic fatigue syndrome, depression, anxiety, and PTSD.

Take Home Pearls: Migraines appear to be common among patients with fibromyalgia. Several additional medical and psychiatric comorbidities appear to be common in this patient population.

Influences on Health Behavior Change in Chronic Pain

The Particulars: Treatment non-adherence and dropout are common among patients who are prescribed behavioral therapy for pain. Assessing the influences of health behavior change in patients with chronic pain could help identify those at risk for treatment dropout.

Data Breakdown: University of Florida investigators assessed the cognitive motivational influences on health behavior change among adults with chronic musculoskeletal pain who participated in a study. Patients expected that engaging in health behavior changes would improve their pain-related symptoms by 21% to 34% but reported they would require improvements of 45% to 52% in order to feel that it was worthwhile to practice these behaviors. Participants frequently endorsed using self-confidence and motivation to eat a healthy diet as strategies to use but expected to benefit the most from practicing relaxation and activity pacing.

Take Home Pearl: Adults with chronic pain appear to require more symptom benefits than expected from practicing healthy behaviors like diet and exercise.

Estimating Pediatric Chronic Pain Expenditures

The Particulars: Pediatric chronic pain is increasingly being recognized as a major cause of morbidity in children. Although data are emerging on the associated economic costs to families, estimates of national healthcare expenditures on chronic pain in children and adolescents are lacking.

Data Breakdown: Researchers analyzed data from a nationally representative sample of children aged 6 to 17 to assess the impact of pediatric chronic pain on national healthcare expenditures and compared these data with other common childhood conditions. Pediatric chronic pain was associated with $11.8 billion in total incremental healthcare expenditures. These costs were similar to those for ADHD ($9.23 billion), but they were higher than those associated with asthma ($5.35 billion) and obesity ($0.73 billion) in childhood.

Take Home Pearl: Healthcare expenditures for pediatric chronic pain appear to exert a considerable economic burden on society.

Assessing the Likelihood of OINV

The Particulars: Currently, clinicians must rely on unclear historical factors when determining which patients may develop opioid-induced nausea and vomiting (OINV). A greater understanding of whether or not patients deemed to be possibly at risk for OINV actually develop the condition could help guide treatment.

Data Breakdown: For a study, researchers observed OINV outcomes in a sample of presumably less at-risk, oral surgery patients. Among those treated with an opioid, 61% reported moderate or severe nausea at least once. The study team also found that 22% vomited at least once, and 24% required at least one dose of an antiemetic.

Take Home Pearl: About two-thirds of patients with acute pain who are thought of as being possibly at risk for OINV appear to actually develop the condition.

Predicting Opioid Abuse

The Particulars: Evidence suggests that it can be difficult for clinicians to identify patients who are at increased risk for abusing prescription opioids. Establishing those at high risk for this abuse may be of benefit.

Data Breakdown: Researchers performed a retrospective chart review of initial clinical visits to assess prescription opioid abuse among a cross-sectional cohort of 625 patients. A history of drug or alcohol treatment, a current legitimate opioid prescription, and nightmares from pain increased the odds of prescription opioid abuse. Conversely, the authors found that patients who slept more on average each night were at lower risk for such abuse.

Take Home Pearls: Patients with a history of drug or alcohol treatment appear to be at higher risk for prescription opioid abuse. Some patients may be self-medicating with opioids for concurrent sleep disorders, an association that warrants further study.